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Wednesday, January 28, 2015

Check the Ether...

I am often amazed, not only where I work but in the rest of real life, by the perceptions people have as to how the world works.
Yesterday's rather mundane offering brings us this (mostly true) story:

CP: Thank you for calling Chronicles' Pharmacy (CP). How may I help you?
White Witch: I was calling to see if my prescription was ready?
CP: That's a statement disguised as a question. Are you Canadian?
WW: No. My name is White Witch.
CP: Sounds like you were picked on as a kid. Have we filled for you before?
WW: Yes. I come there all the time.
CP: It appears we have not filled for you since 2012. Are you sure it was sent here?
WW: Yes. I get all my medications there.
CP: You must be pretty healthy to have not needed anything since that one antibiotic in 2012. I have nothing for you today.
WW: Did you check the voicemail?
CP: <audible sigh> Yes, m'lady. I checked the e-script queue, the faxes, the phone-ins, the voicemail, my text alerts, my personal email, the Pony Express satchel, the telegraph machine, and my partner went out back looking for smoke signals. There is no prescription anywhere in our store for you. We have received nothing. We have filled nothing. Nothing since 2012. Does this answer your statement-question?
WW: Did you check the drawer? (Seriously. She asked this without missing a beat.)
CP: To what drawer are you referring? Our will call bin that doubles as a secret portal to Narnia? Do you expect we are able to open this drawer, peek inside, and suddenly we will have magic insight into all pharmacies' inventories and prescription files? Truly if this existed, it would not be located in a drawer. I am almost certain there'd be an app for that.
WW: So you don't have anything, then?
CP: I could check the freezer.
WW: Would you?
CP: No.

Wednesday, January 21, 2015

Wheel of Excuses

Is there a blog, website, twitter page, something devoted to "Top Excuses to Give Your Pharmacy"?
If not, it was my idea first...
Everyone has heard the same excuses. I know it varies across the USA, but at every store I've worked in my state, when someone has a relative who dies, it always happens in the neighboring state to the Southeast. For whatever reason, the Grandmas always live immediately out-of-state to the East. Always.
Is it the same excuses in the other states too?
Does this also happen in other countries?

It's the same with the relatives who visit. I'm not sure what makes my State the Bermuda Triangle for prescriptions but when out-of-staters visit, they prefer to leave their medications and supplies at home. Either that or they didn't bring enough to last. Because we are so awesome to visit, time flies and the supplies disappear.



Thursday, January 15, 2015

What to do Now?

We cannot think for ourselves anymore. We can, but we either chose not to do so, or we have forgotten how. Technology has made us dumb and too reliant upon it. Want proof? Hand some extra change to a cashier after she has rung up your sale. The look of confusion is priceless. Ask someone for a phone number and they don't have it memorized, they have to look it up in their phone. Better yet, what happens when AT&T goes down?

These are minor things that illustrate a greater problem. What do you do when your prescriber, your hospital, your pharmacy has moved everything to electronic records…and the power goes or the system crashes? Obviously not this. (I had one office switch to all electronic records and they moved all paper records offsite immediately.) Not too smart. Here's why…

Forgetful Folks: Dr. Zoffis, how may we help you?
CP: I was calling about this patient standing in from of me.
FF: He was just here. Bless his little heart.
CP: Indeed bless it. Apparently you were trying to stop it.
FF: Que?
CP: Patient has a severe penicillin allergy.
FF: Okay.
CP: You prescribed him penicillin.
FF: Okay.
CP: Severe as in rash, hives, anaphylaxis, death a couple times. Severe.
FF: "Oh. Our EMR system was down for system maintenance so we couldn't check." (Yep. Actual quote.)
CP: I see. Uh-huh. Uh-huh. Question for you.
FF: Go ahead.
CP: Could the patient talk?
FF: Yes. He's very pleasant.
CP: So it never occurred to you to actually just ASK him if he had any allergies? You never thought to tell him "we are giving you penicillin. any problems with that."?
FF: Um.
CP: So simple. I wish I could fire your whole office for stupidity. At least I have a new name to add to my list of "prescribers who are not allowed to treat me".

Wednesday, January 7, 2015

Deck of Cards

We have so many cards on our person.
We have customer loyalty cards, insurance cards, credit cards, licenses, and memberships, all tucked away in our wallets. One thing that always amazes me, and I know it should not, is that people rarely have their insurance cards with them.

What happens when...
...your new credit card arrives in the mail? You sign it and put it in your wallet.
...your new license is handed to you? You put it in your wallet.
...you receive a new FroYo Frequent Flier Card? It goes in your wallet or on your keychain.

...you receive your new insurance card? It goes in a drawer or thrown in with the mail on a desk somewhere.

Maybe insurance companies should design a keyring version of these cards.
Of course the inevitable would follow: people would hand you a 4" diameter  ring that looks like an Etsy Christmas wreath that has every medical, dental, prescription, and rewards card ever received and expect you to figure out which one is correct.

Tuesday, December 30, 2014

Happy New Year! (Or Not…)

My first resolution this year is to do less.
I resolve to do less for other people...
but...I resolve to give people the knowledge and training to do things for themselves.
I resolve to not call your prescriber for your refills.
I resolve to not care about your prior authorization for an expensive acne cream from your dermatologist.
I resolve to not call your prescriber to fix his handwriting errors anymore.
I resolve to just say "NO" to your ridiculous expectations.
I resolve to throat punch you if you use the phrase "slap a label on it".

My second resolution is that I resolve to do more.
More talking with patients about their medications.
Taking more time to do the actual professional functions of my job…the ones that came with my college education and not the ones patients and corporations think are my job.
More fighting for my profession and my colleagues.
More putting the onus back where it belongs: on the patient, the prescriber, the insurance, the "man", or whoever may be responsible who is not me. (Because everyone thinks it's the pharmacist's phault.)

I resolve to post a sign about realistic expectations:
1. You must present your insurance card every time you drop off a prescription. I don't care if you have been here before, even if it was 167 minutes ago, I still expect you to hand it to me. (Your prescriber has this policy posted and you don't complain there.)
2. Your wait time will be based on the ever-fluctuating amount of work I have to do and CAN and WILL be adjusted to fit your attitude.
3. Copays are non-negotiable. There is no arguing with the pharmacy staff. Attempting to do so will result in longer wait times for you on all phuture drop offs for the rest of the year. (See #2.)
4. Prices are set by your insurance. I can point out their phone number on the back of your insurance card (because you obeyed Step #1) for you to call them directly. First, you must step out of line. Second, see #2.
5. You have the right to a consultation just like everyone else. Just because you opt to forgo this every time you are here does not mean others should be expected to do so as well. Their time is just as valuable as yours. If you complain, please see #2.
6. Just because everything went smoothly the last time you were here (no line, no wait, medication in stock, no insurance issues, etc.) does NOT mean this trend will continue. It's like the stock market: past results are not predictors of the phuture.
7. If you expect to have a good experience at my pharmacy, be a good patient. Be prepared. Obey #1. Know your insurance. If you expect your prescriber sent us a prescription, please call before coming to the pharmacy. Also, do not go directly to the pickup line. Stop by the consultation or drop off window and verify we received it and it has been processed. It could be in any stage of completion at this point and you needn't waste 20 minutes in the pickup line only to be told it's in the work queue or our stack of faxes/voicemails, etc. that have yet to be run and you have to get back in line when we are done. This also allows you to be compliant with Step #1…
8. If your prescription is waiting to be picked up and in my will call section, you are welcome to pay the price attached to it and leave with it. Asking me to add a discount card, try multiple manufacturer discounts, or change anything about the completed, ready prescription will result in you stepping out of line and increase your wait to that of the current wait time in my pharmacy. At this point I am not the person making you wait. YOU are. This will result in you being issued a business card with #2 printed on it…(Both the policy and a picture.) If you had read #7 and been a good patient, you would have called ahead and taken care of this before getting in the pickup line.
9. If you call me from the drive thru asking what is taking so long, my answer will be as follows: "It is taking longer than expected because I had it filled then all these people showed up, much like you, and wanted their prescriptions too. Imagine that. At a pharmacy, no less. In order to provide you with speedier service, I deleted your prescription and called over to the pharmacy across the street. They said it would be ready in 15 minutes so I transferred it there, along with your complete profile. I invoked #2 to the fullest extent. Thank you and good day."
10. Prices: It's not free here. It's not $4.00 here. It's not anything other than what I told you it was. Remember, YOU chose to do business with ME. I did not drag you off the street and force you to fill prescriptions here any more than Home Depot forced you to buy a fridge from them instead of Lowe's. It is a free country and I resolve to help you in many ways but begging you to be my patient is not on my to-do list.
11. Gift Cards: You want one, buy one.
12. I will only care about your health as much as you do. The less you care about it, the less I do.
13. Obeying all the pharmacy rules will not only expedite your service today and in the phuture, but will make the world a better place, one patient and unreasonable expectation at a time...

Thursday, December 11, 2014

The 12 Days of Pharmacy

On the Twelfth Day of Pharmacy, a patient said to me…
...let me speak to your manager.
...it's a drive-thru, not a stop and park.
...what's the best thing you got?
...you were s'posed to match the price.
...didn't my insurance work?
…how do I get a gift card?
...15 minutes? Why so long?

...it's just a box!
...just slap a label on it.
…saw my doctor send it.
...all you do is count by 5's!
...I thought antibiotics were free.



A Doctor sent to me...
12 duplicate e-scripts,
11 faxed copies of it,
10 voicemail messages,
9 patients expecting $4 copays,
8 illegible prescriptions,
7 narcs with no dea#
6 refill request denials,
5 prior auth rejections,
4 people told "it'll be ready for you"
3 scripts missing signatures,
2 scripts meant for another pharmacy,
and a patient expecting everything to be free!

Thursday, December 4, 2014

If the Real World Worked As People Believe the Pharmacy Does

Bank Teller: Thank you for coming into the bank. No one does anymore.
CP: And there are still just as few employees as there ever were.
BT: How may I help you?
CP: I should like to inquire as to the status of my payroll funds. They were to be direct deposited this morning.
BT: Do you have your account number?
CP: No. I have used other Bank of America locations before. Just look me up.
BT: But this is Chase.
CP: Aren't you all connected?
BT: No. No more than Walgreen's and Rite Aid share a computer.
CP: Oh. Well is my deposit here?
BT: I can't seem to locate it.
CP: What? They said it would be here. Can you check my friend's account? They sent our payroll at the same time.
BT: I show a deposit made today for that person, but nothing for you.
CP: What? I watched them send it. I put the direct deposit account info in myself and faxed it directly to payroll yesterday!
BT: It can take up to 2 weeks for it to get approved. Check your mailbox for a cheque.
CP: This is why I quit coming here to KeyBank.
BT: We are Chase.
CP: Can't you give me enough money to get through until my cheque arrives? I'm out. There's a great deal on Chia Pets at the local CVS and I need to stock up before they sell out.

Tuesday, December 2, 2014

Proof Pharmacy Exists Outside the Real World

CP: Good Morning and welcome to the first of the month where reality ceases to exist. How may I help you?
Dazed and Confused Mother: I need to fill this prescription for my son. He's never been here before.
CP: Welcome to you both. Let me get all your information.
DCM: I'm already in the system.
CP: Peachy. As you said, he is not. I shall need to enter him from scratch.
DCM: But I've been here before!
CP: And I've been to California before.
DCM: <Puzzled look>
CP: Do you have his insurance card?
DCM: No.
CP: I need it in order to process the prescription to it. Or I can charge you the exorbitant cash price of $5.00.
DCM: No way! He has insurance. It's Medicaid. <Looks at me expectantly>
CP: <Looks at her with matched expectancy>

hours pass…
DCM: Aren't you going to look it up?
CP: Question for you.
DCM: Okay.
CP: Did you have a good Thanksgiving?
DCM: Yes?
CP: Did you do some Black Friday shopping?
DCM: Of course.
CP: Get some good deals?
DCM: Yes. <explains a few purchases>
CP: How'd you pay?
DCM: Credit card.
CP: You knew you were going shopping, right?
DCM: Of course.
CP: You planned your trip? Which stores to hit? Who had the best deals? What to buy where? You made sure you had your purse and your wallet?
DCM: Yes.
CP: With your credit cards inside?
DCM: Duh!
CP: If you had made it all the way to the front of the line with your new 50" TV, XBox, and other purchases and realised you didn't have your credit card, would you have asked them to just look it up?
DCM: No. That's ridiculous.
CP: Do you think they would have called Visa simply because someone in your house had shopped there once before?
DCM: No.
CP: So you're expecting me to believe that you forgot your Welfare Credit Card, went to the doctor, received a prescription, knew you were coming to the pharmacy, and now you're expecting me to fix your problem for you? In what world are you living? Never mind the fact that you scoffed at $5 for this prescription but you just spent over $500 on new electronics last weekend.
DCM: So I should go home and get it?
CP: That would be ideal. Or you could return some items and scrape up the cash for the copay?
DCM: <Sends son to the car> He found it!
CP: Okay. That'll be 25 minutes to wait now.
DCM: What? Why so long?
CP: How long did you wait in line for all that crap you just bought? It's now 45 minutes.